Prevalence of metronidazole resistant Helicobacter pylori strains among Chinese peptic ulcer disease patients and normal controls in Hong Kong.

Ching, C. K.; Leung, KL; Yung, R; Lam, Shiu Kum; Wong, Benjamin C.Y.; Lai, Kwok-Hung; Lai, CL

doi:10.1136/gut.38.5.675

Cited by 53 publications

(51 citation statements)

References 18 publications

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“…It further implies that patients in an Asian population without PUs are more likely to harbor metronidazole-resistant H. pylori strains. The difference between the two studies rested on a comparison of asymptomatic subjects (healthy volunteers) and PU patients (3), while the present findings were based on a controlled study with consecutive patients with dyspeptic symptoms (patients with NUD and patients with PU). However, in another study with asymptomatic subjects, Vaira et al (21) showed that of 128 of 1,010 asymptomatic blood donors who were seropositive and who had consented to endoscopy, 121 had chronic active gastritis.…”

Section: Discussionmentioning

confidence: 99%

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Metronidazole-Resistant Helicobacter pylori Is More Prevalent in Patients with Nonulcer Dyspepsia than in Peptic Ulcer Patients in a Multiethnic Asian Population

Lui¹,

Yeoh

Ho³

2003

J Clin Microbiol

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The trend of increasing prevalence of antibiotic resistance among Helicobacter pylori strains has been suggested as a cause of the failure of treatment of H. pylori infections. In this study, 120 of 211 antral biopsy specimens from patients with dyspeptic symptoms were found to harbor H. pylori. The isolates from the 120 specimens were tested by the agar dilution method, and 38 (31.7%) were found to be metronidazole resistant. Among the 211 subjects, 81 of 115 (70.4%) patients with peptic ulcer (PU) were infected with H. pylori, whereas 39 of 96 (40.6%) patients with nonulcer dyspepsia (NUD) were infected with H. pylori. Interestingly, significantly more NUD patients than PU patients harbored metronidazole-resistant H. pylori ( Helicobacter pylori is a gram-negative spiral microorganism that is closely associated with gastritis and peptic ulcer (PU) diseases. It was noted that a substantial number of subjects with nonulcer dyspepsia (NUD) also harbor the bacterium. The triple therapy used to treat H. pylori infection, consisting of bismuth subsalicylate and two antibiotics, usually metronidazole and tetracycline or amoxicillin, has been found to result in an eradication rate of approximately 90% (18). However, the effect of this treatment was found to be compromised when the patient harbors H. pylori isolates that are drug resistant (15,16,19). The prevalence of resistance to metronidazole has increased or remained steady over the past few years in several countries, including Singapore (3, 4, 6).The disk diffusion test is routinely used to determine sensitivities to antibiotics, as it is economical and easy to perform (17). However, the agar dilution method, although tedious to perform, is still the reference method for the testing of antibiotic susceptibility (13). This method not only determines the antibiotic susceptibility but also the MICs for the bacteria. The commercially available E-test is a method that combines the advantages of the disk diffusion and agar dilution methods, as it is easy to use and also provides the MICs for the bacteria tested (5). However, the E-test is a commercial kit and for routine use is more costly than the agar dilution method, and studies have shown discrepancies in the results obtained by the two methods (1,14).In this study, we examined the relevance of metronidazole resistance in patients with PU and NUD, while the agar dilution method was used to determine the MICs for the H. pylori isolates. MATERIALS AND METHODSProcessing of biopsy specimens. A total of 211 consecutive patients with dyspeptic symptoms were included in this study. Of these, 115 patients had PU, while 96 patients had NUD. PUs include duodenal or gastric ulcers, or both, while NUD is defined as dyspeptic symptoms but a lack of endoscopic evidence of an ulcer (27). The ages of the patients ranged from 17 to 86 years, with an average age of 45.7 years. Of the 211 patients, 133 were males and 78 were females. The study included 175 Chinese, 14 Malays, 14 Indians, and 8 patients of other ethnicities. Informed...

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Section: Discussionmentioning

confidence: 99%

“…However, the effect of this treatment was found to be compromised when the patient harbors H. pylori isolates that are drug resistant (15,16,19). The prevalence of resistance to metronidazole has increased or remained steady over the past few years in several countries, including Singapore (3,4,6).…”

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confidence: 99%

Metronidazole-Resistant Helicobacter pylori Is More Prevalent in Patients with Nonulcer Dyspepsia than in Peptic Ulcer Patients in a Multiethnic Asian Population

Lui¹,

Yeoh

Ho³

2003

J Clin Microbiol

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“…2). It has been shown in prior studies in Alaska and elsewhere that the increased resistance of H. pylori isolates in females may be due primarily to the increased prescription of metronidazole for gynecological infections (6,11).…”

Section: Discussionmentioning

confidence: 99%

Alaska Sentinel Surveillance Study of Helicobacter pylori Isolates from Alaska Native Persons from 2000 to 2008

et al. 2011

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Helicobacter pylori infection is more common in Alaska Native persons than in the general U.S. population, with seroprevalence to H. pylori approaching 75%. Previous studies in Alaska have demonstrated elevated proportions of antimicrobial resistance among H. pylori isolates. We analyzed H. pylori data from the Centers for Disease Control and Prevention's sentinel surveillance in Alaska from January 2000 to December 2008 to determine the proportion of culture-positive biopsy specimens with antimicrobial resistance from Alaska Native persons undergoing endoscopy. The aim of the present study was to monitor antimicrobial resistance of H. pylori isolates over time and by region in Alaska Native persons. Susceptibility testing of H. pylori isolates to metronidazole, clarithromycin, amoxicillin, and tetracycline was performed using agar dilution. Susceptibility testing for levofloxacin was performed by Etest. Overall, 45% (532/1,181) of persons undergoing upper endoscopy were culture positive for H. pylori. Metronidazole resistance was demonstrated in isolates from 222/531 (42%) persons, clarithromycin resistance in 159/531 (30%) persons, amoxicillin resistance in 10/531 (2%) persons, and levofloxacin resistance in 30/155 (19%) persons; no tetracycline resistance was documented. The prevalence of metronidazole, clarithromycin, and levofloxacin resistance varied by region. Female patients were more likely than male patients to demonstrate metronidazole (P < 0.05) and clarithromycin (P < 0.05) resistance. No substantial change in the proportion of persons with resistant isolates was observed over time. Resistance to metronidazole, clarithromycin, and levofloxacin is more common among H. pylori isolates from Alaska Native persons than those from elsewhere in the United States.Helicobacter pylori is the major cause of gastric and duodenal ulcers and is associated with chronic active gastritis (27). Infected persons are at increased risk for mucosa-associated lymphoid tissue (MALT) lymphoma and gastric adenocarcinoma (2, 15). Over half of the world's population is currently infected with H. pylori; rates of approximately 40% seropositivity have been found among persons living in industrialized countries, compared to 80 to 90% among persons living in developing countries (1, 7). In Alaska, the overall seroprevalence among Alaska Native persons is approximately 75% (range among regions, 64 to 81%) (23).Previous studies have demonstrated elevated proportions of resistant H. pylori isolates from Alaska compared with the rest of the United States (7,10,12,18,21). We analyzed data from the Centers for Disease Control and Prevention's (CDC) H. pylori sentinel surveillance system in Alaska from 1 January 2000 to 31 December 2008 to determine the proportion of H. pylori culture-positive biopsy specimens from Alaska Native persons undergoing upper endoscopy and to determine the susceptibility of H. pylori isolates to antibiotics (metronidazole, clarithromycin, levofloxacin, amoxicillin, and tetracycline) commonly used in the treatm...

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“…Treatment failure has been attributed to patient compliance and antimicrobial drug resistance (9)(10)(11) . H. pylori strains may be diverse in infected patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, culturing of biopsies is still commonly used for diagnosis and may be of increasing importance as a tool to monitor the in vivo presence of H. pylori and antibiotic-resistant H. pylori strains in gastric tissues after antibiotic therapy. Regimens incorporating metronidazole have been the most effective for eradicating H. pylori, but recent studies showed the increasing prevalence of metronidazole-resistant H. pylori, and a significantly lower eradication rate in patients harboring metronidazoleresistant strains (9)(10)(11)(12). This study examined the prevalence of H. pylori in gastric biopsies by histological identification and bacterial culture among patients with gastroduodenal diseases in central Taiwan.…”

Section: Introductionmentioning

confidence: 99%

Helicobacter Pylori in Gastric Biopsies of Taiwanese Patients With Gastroduodenal Diseases

Lin

Chang²,

et al. 1998

JJMSB

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SUMMARY: This study was designed to study the in vivo prevalence and the heterogeneity of H, pylori in patients with gastroduodenal diseases in central Taiwan. H. pylori infection was detected in 74.1% (575/776) of the symptomatic population studied. The prevalence of H. pylori infection increased from 11.1% in those between the ages of one to 20, to 82.9% in those between the ages of 41 and 50, and to 84% in those between the ages of 51 and 60. There was no significant difference in the prevalence of H. pylori infection between men and women. Among different blood types, the prevalence and relative risk of H. pylori infection was significantly higher in blood group O patients (90.3%) than in blood group A (41%), blood group B (27.4%), or blood group AB (62%) patients. Metronidazole resistance was found in 6.7% of the primary isolates. The prevalence of metronidazole-resistant H. pylori strains was higher in women (7.69%) than in men (6.25%), but this difference was not significant. A total of 88% of H. pylori strains were cagA-positive. CagA gene-positive strains were present in 90.1% of duodenal ulcers, 90% of duodenal ulcers combined with gastric ulcer, 85.8% of gastric ulcers, and 69.2% of gastritis patients, and was significantly higher in peptic ulcer disease groups than in the gastritis group. In conclusion, there was a low incidence (6.7%) of metronidazole-resistant H. pylori strains and a high prevalence (88%) of H. pylori cagA -positive strains in central 13

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Prevalence of metronidazole resistant Helicobacter pylori strains among Chinese peptic ulcer disease patients and normal controls in Hong Kong.

Cited by 53 publications

References 18 publications

Metronidazole-Resistant Helicobacter pylori Is More Prevalent in Patients with Nonulcer Dyspepsia than in Peptic Ulcer Patients in a Multiethnic Asian Population

Metronidazole-Resistant Helicobacter pylori Is More Prevalent in Patients with Nonulcer Dyspepsia than in Peptic Ulcer Patients in a Multiethnic Asian Population

Alaska Sentinel Surveillance Study of Helicobacter pylori Isolates from Alaska Native Persons from 2000 to 2008

Helicobacter Pylori in Gastric Biopsies of Taiwanese Patients With Gastroduodenal Diseases

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